Diaz Esperanza, Neuse Elizabeth, Sullivan Michelle C, Pearsall H Rowland, Woods Scott W
Department of Psychiatry and the Treatment Research Program, Yale University, 34 Park Street, Room 273A, New Haven, CT 06519, USA.
J Clin Psychiatry. 2004 Mar;65(3):354-60. doi: 10.4088/jcp.v65n0311.
This prospective study measured adherence to conventional and atypical antipsychotics after hospital discharge in patients with a diagnosis of schizophrenia and schizoaffective disorder. We examined the interaction of several predictors such as gender, severity of illness, attitudes toward medications, side effects, and dose frequency.
The sample consisted of consecutive randomized and nonrandomized patients who were discharged from an inpatient unit with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder between December 1995 and July 1999. All patients were taking oral antipsychotics and consented to the use of an electronic adherence monitor at discharge. Medications were prescribed by usual care providers, and medication adherence was followed weekly for 3 months. The outcome measure was the medication adherence rate registered in the electronic monitors.
We found no significant difference in adherence between the combined groups of atypical and conventional antipsychotics. Individual medication analysis found better medication adherence with olanzapine in comparison with risperidone and conventional antipsychotics, but the difference disappeared in the final model controlling for dose frequency. Dose frequency, gender, and akathisia predicted adherence.
Olanzapine initially appeared to be associated with an adherence advantage over risperidone and conventional antipsychotics, but the apparent advantage may have been due to a usual care dose frequency practice that associated olanzapine more often with once-daily dosing. This study suggests that dose frequency is an important predictor of medication adherence. An important caveat is that these results apply only to short-term adherence.
这项前瞻性研究测量了精神分裂症和分裂情感性障碍患者出院后对传统抗精神病药物和非典型抗精神病药物的依从性。我们研究了性别、疾病严重程度、对药物的态度、副作用和给药频率等几个预测因素之间的相互作用。
样本包括1995年12月至1999年7月间从住院部出院的连续随机和非随机患者，他们的诊断为DSM-IV精神分裂症或分裂情感性障碍。所有患者均服用口服抗精神病药物，并在出院时同意使用电子依从性监测器。药物由常规护理人员开具，每周对药物依从性进行跟踪，持续3个月。结果测量指标是电子监测器记录的药物依从率。
我们发现非典型和传统抗精神病药物联合组之间的依从性没有显著差异。个体药物分析发现，与利培酮和传统抗精神病药物相比，奥氮平的药物依从性更好，但在控制给药频率的最终模型中，这种差异消失了。给药频率、性别和静坐不能预测依从性。
奥氮平最初似乎比利培酮和传统抗精神病药物具有依从性优势，但这种明显的优势可能是由于常规护理给药频率的做法，使奥氮平更常与每日一次给药相关。这项研究表明给药频率是药物依从性的一个重要预测因素。一个重要的注意事项是，这些结果仅适用于短期依从性。
